Nudging to move: a scoping review of the use of choice architecture interventions to promote physical activity in the general population.

BACKGROUND: Nudges are used to alter lifestyles and thus curb the rise of non-communicable diseases. Physical activity is a core prevention strategy to reduce the burden of non-communicable diseases. This paper aims to (1) give an overview of the scope of interventions using choice architecture techniques to promote physical activity at the population levels and (2) identify research gaps by analysing the different approaches in terms of class and type of intervention used. METHODS: A systematic electronic database search was combined with snowball citation sampling of a starter set of publications to search for studies published through October 2018 reporting interventions to promote physical activity at the population level using choice architecture techniques. The methodology of the Joanna Briggs Institute for Scoping Reviews was applied. RESULTS: In all, 35 publications were included. Most of the interventions used point-of-choice prompts tested at railway stations, shopping malls and airports (N = 27). Eight studies were online studies. While all studies were aimed at the general population, details, if reported at all, were vague and basic. All studies focused on individual-level lifestyle behaviour. None of the studies attempted to alter population-based lifestyle behaviour. Online and "real-world" approaches were rarely combined. Neither, interventions targeting meso- and macro-level structures nor combinations of individual-level and specific meso- or macro-level interventions were found. CONCLUSION: Nudging is in principle an effective approach to promote physical activity within the general population. However, there are large gaps in research. Available opportunities have not yet been exhausted. Further research is needed that is explicitly based on behavioural insights and covering the full range of nudging approaches, particularly focussing on theoretical developments, practical feasibility tests and scale-up activities.

A within-sibling pair analysis of lifestyle behaviours and BMI z-score in the multi-centre I.Family study.

BACKGROUND AND AIMS: By investigating differences in lifestyle behaviours and BMI in sibling pairs, family-level confounding is minimized and causal inference is improved, compared to cross-sectional studies of unrelated children. Thus, we aimed to investigate within-sibling pair differences in different lifestyle behaviours and differences in BMI z-scores in children and adolescents. METHODS AND RESULTS: We examined three groups of sibling pairs 1) all same-sex sibling pairs with maximum 4 years age difference (n = 1209 pairs from 1072 families in 8 countries, mean age 10.7 years, standard deviation 2.4 years), 2) sibling pairs discordant for overweight (n = 262) and 3) twin pairs (n = 85). Usual dietary intake was estimated by 24-h recalls and time spent in light (LPA) and moderate-to-vigorous physical activity (MVPA) was measured by accelerometers. Screen time, sleep and dieting for weight loss were assessed by questionnaires. Within all 3 groups of sibling pairs, more time in MVPA was associated with lower BMI z-score. Higher energy intake was associated with higher BMI z-score within twin pairs and within all sibling pairs who were not currently dieting for weight loss. Regarding LPA, screen time or sleep duration, no or inconsistent associations were observed for the three groups of sibling pairs. CONCLUSIONS: MVPA and energy intake were associated with BMI differences within sibling and twin pairs growing up in the same home, thus independent of family-level confounding factors. Future studies should explore whether genetic variants regulating appetite or energy expenditure behaviours account for weight differences in sibling pairs.

Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children.

INTRODUCTION: This study aims to evaluate a potential selection effect caused by exclusion of children with non-identifiable infancy peak (IP) and adiposity rebound (AR) when estimating associations between age and body mass index (BMI) at IP and AR and later weight status. SUBJECTS AND METHODS: In 4744 children with at least 4 repeated measurements of height and weight in the age interval from 0 to 8 years (37 998 measurements) participating in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants)/I.Family cohort study, fractional polynomial multilevel models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years). RESULTS: Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r⩾0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4-6 years (r⩾0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results differed for children with non-identifiable IP and AR, demonstrating a selection effect. CONCLUSIONS: IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead.

The impact of familial, behavioural and psychosocial factors on the SES gradient for childhood overweight in Europe. A longitudinal study.

BACKGROUND: In highly developed countries, childhood overweight and many overweight-related risk factors are negatively associated with socioeconomic status (SES). OBJECTIVE: The objective of this study is to investigate the longitudinal association between parental SES and childhood overweight, and to clarify whether familial, psychosocial or behavioural factors can explain any SES gradient. METHODS: The baseline and follow-up surveys of the identification and prevention of dietary and lifestyle induced health effects in children and infants (IDEFICS) study are used to investigate the longitudinal association between SES, familial, psychosocial and behavioural factors, and the prevalence of childhood overweight. A total of 5819 children (50.5% boys and 49.5% girls) were included. RESULTS: The risk for being overweight after 2 years at follow-up in children who were non-overweight at baseline increases with a lower SES. For children who were initially overweight, a lower parental SES carries a lower probability for a non-overweight weight status at follow-up. The effect of parental SES is only moderately attenuated by single familial, psychosocial or behavioural factors; however, it can be fully explained by their combined effect. Most influential of the investigated risk factors were feeding/eating practices, parental body mass index, physical activity behaviour and proportion of sedentary activity. CONCLUSION: Prevention strategies for childhood overweight should focus on actual behaviours, whereas acknowledging that these behaviours are more prevalent in lower SES families.

Does the FTO gene interact with the socioeconomic status on the obesity development among young European children? Results from the IDEFICS study.

BACKGROUND: Various twin studies revealed that the influence of genetic factors on psychological diseases or behaviour is more expressed in socioeconomically advantaged environments. Other studies predominantly show an inverse association between socioeconomic status (SES) and childhood obesity in Western developed countries. The aim of this study is to investigate whether the fat mass and obesity-associated (FTO) gene interacts with the SES on childhood obesity in a subsample (N = 4406) of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) cohort. METHODS: A structural equation model (SEM) is applied with the latent constructs obesity, dietary intakes, physical activity and fitness habits, and parental SES to estimate the main effects of the latter three variables and a FTO polymorphism on childhood obesity. Further, a multiple group SEM is used to explore whether an interaction effect exists between the single nucleotide polymorphism rs9939609 within the FTO gene and SES. RESULTS: Significant main effects are shown for physical activity and fitness (standardised [betacrc ](s) = -0.113), SES ([betacrc ](s) = -0.057) and the FTO homozygous AA risk genotype ([betacrc ](s) = -0.177). The explained variance of obesity is ~9%. According to the multiple group approach of SEM, we see an interaction between SES and FTO with respect to their effect on childhood obesity (Δχ(2) = 7.3, df = 2, P = 0.03). CONCLUSION: Children carrying the protective FTO genotype TT seem to be more protected by a favourable social environment regarding the development of obesity than children carrying the AT or AA genotype.

Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study.

BACKGROUND/OBJECTIVES: To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. METHODS: The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. RESULTS: In a cohort of 18,745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17,212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time-below 1 h for pre-school children and 2 h for school children-was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered to at least five of these recommendations. CONCLUSIONS: Current adherence of children to lifestyle recommendations to prevent childhood obesity is low where observed differences with respect to country, age and gender call for targeted intervention.

Instruments for analysing the influence of advertising on children's food choices.

OBJECTIVE: The aim of this report was to present methodological aspects of assessing the effects of advertising on children's food choices and preferences. METHODS: Two instruments have been used: first, a choice experiment on children's food knowledge and preferences, and second, a questionnaire on children's knowledge about and attitudes towards advertising. The choice experiment employed 10 matched pairs of food items, each represented in two magazines, one that tested knowledge and the other food preferences. The children's questionnaire contained four dimensions that tested children's credibility and suspiciousness of, as well as entertainment by, advertising. Although based on already developed tools, both instruments were modified to suit the young target group and ensure cross-cultural comparability. The questionnaire was validated via Cronbach's alpha and factor analysis. SUBJECTS: A total of 393 children aged 5-11 years from seven European countries participated in the study. RESULTS: Both instruments proved to be valid and reliable to analyse the food knowledge and preferences of children, as well as knowledge about and attitudes towards advertising. While 92.2% of the children predominantly recognised the healthier food, only 33.2% also preferred the healthier food. The Cronbach's alpha values for the dimensions were 0.470 for credibility, 0.409 for suspiciousness and 0.295 for entertainment factor. The gathered data revealed that children are rather critical and suspicious of advertising and only moderately entertained. CONCLUSION: Both instruments are applicable for the 5- to 11-year-old age group in different European countries. Descriptive results indicate additional insights into the effects of advertising on children's food knowledge, preferences and food choice.

Repeatability of maternal report on prenatal, perinatal and early postnatal factors: findings from the IDEFICS parental questionnaire.

OBJECTIVE: To investigate the repeatability of maternal self-reported prenatal, perinatal and early postnatal factors within the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study. DESIGN: Data are from the baseline survey of the longitudinal cohort study IDEFICS in eight European countries. SUBJECTS: A total of 420 parents from eight countries (43-61 per country) were asked to complete the parental questionnaire (PQ) twice at least 1 month apart. MEASUREMENTS: The PQ assesses prenatal (maternal weight gain), perinatal (child's birth weight and length, Caesarean (C)-section, week of delivery) and early postnatal factors (exclusive breastfeeding, breastfeeding, introduction of solid food). Intra-class correlation coefficients (ICCs) were calculated to compare maternal reports on prenatal, perinatal and early postnatal factors between the first and second PQ. RESULTS: In total, 249 data sets were considered for the analyses. Overall, maternal reports for prenatal and perinatal factors showed higher repeatability (ICC=0.81-1.00, P≤0.05 for all) than those for early infant nutrition (ICC=0.33-0.88, P≤0.05 for all). Perfect agreement was found for parental reports on C-section (ICC(all)=1.00, P≤0.05). There was stronger agreement for duration of breastfeeding (ICC=0.71, P≤0.05) compared with exclusive breastfeeding (ICC=0.33, P≤0.05). Maternal reports showed moderate correlation for the introduction of several types of food (cereals ICC=0.64, P≤0.05; fruits ICC=0.70, P≤0.05; meat ICC=0.83, P≤0.05; vegetables ICC=0.75, P≤0.05), and high correlation (ICC=0.88, P≤0.05) for cow's milk. CONCLUSION: Maternal reports on pregnancy and birth were highly reproducible, but parental recall of early infant nutrition was weaker and should be interpreted more cautiously.

The IDEFICS cohort: design, characteristics and participation in the baseline survey.

BACKGROUND: The European IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study was set up to determine the aetiology of overweight, obesity and related disorders in children, and to develop and evaluate a tailored primary prevention programme. OBJECTIVE: This paper focuses on the aetiological element of the multicentre study, the measures and examinations, sociodemographic characteristics of the study sample and proportions of participation. DESIGN: Prospective cohort study with an embedded intervention study that started with a baseline survey in eight countries in 2007-2008. SUBJECTS AND MEASUREMENTS: Baseline participants of the prospective cohort study were 16,224 children aged 2-9 years. Parents reported sociodemographic, behavioural, medical, nutritional and other lifestyle data for their children and families. Examinations of children included anthropometry, blood pressure, fitness, accelerometry, DNA from saliva and physiological markers in blood and urine. The built environment, sensory taste perception and other mechanisms of children's food choices and consumer behaviour were studied in subgroups. RESULTS: Between 1507 and 2567, children with a mean age of 6.0 years and an even sex distribution were recruited from each country. Of them, 82% lived in two-parent families. The distribution of standardised income levels differed by study sample, with low-income groups being strongly represented in Cyprus, Italy and Germany. At least one 24-h dietary recall was obtained for two-thirds of the children. Blood pressure and anthropometry were assessed in more than 90%. A 3-day accelerometry was performed in 46%, motor fitness was assessed in 41%, cardiorespiratory fitness in 35% and ∼11% participated in taste perception tests. The proportion of children donating venous blood, urine and saliva was 57, 86 and 88%, respectively. CONCLUSION: The IDEFICS cohort provides valuable data to investigate the interplay of social, environmental, genetic, physiological and behavioural factors in the development of major diet- and lifestyle-related disorders affecting children at present.

The IDEFICS community-oriented intervention programme: a new model for childhood obesity prevention in Europe?

BACKGROUND AND OBJECTIVES: The European Union-as well as other parts of the world-faces a major challenge of increasing incidence of overweight/obesity. In particular, the increase in childhood obesity gives rise to a strong imperative for immediate action. Yet, little is known about the effectiveness of community interventions, and further research in this field is needed. There is, however, a growing consensus that such research should start from the paradigm that the current living environments tend to counteract healthy lifestyles. Questioning these environments thoroughly can help to develop new pathways for sustainable health-promoting communities. Against this background, the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study developed and implemented innovative community-oriented intervention programmes for obesity prevention and healthy lifestyle primarily in children aged 2-10 years in eight European countries: Sweden, Estonia, Germany, Belgium, Hungary, Italy, Spain and Cyprus. MATERIALS AND METHODS: The IDEFICS community-oriented intervention study mobilised an integrated set of interventional efforts at different levels of society, with the aim of facilitating the adoption of a healthy obesity-preventing lifestyle. The overall programme has been composed of 10 modules: three at community level, six at school level and one for parents. The main focus was on diet, physical activity and stress-coping capacity. The sphere of action encompassed both children and their (grand) parents, schools, local public authorities and influential stakeholders in the community. All materials for the interventions were centrally developed and culturally adapted. RESULTS: So far, the following has been achieved: focus group research, literature review and expert consultations were done in an early phase as a basis for the development of the intervention modules. The intervention mapping protocol was followed as guide for structuring the intervention research. The overall intervention programme's duration was 2 years, but a longer-term follow-up programme is under development. CONCLUSIONS: This large-scale European effort is expected to contribute significantly to the understanding of this major public health challenge.

[The impact of consumer behavior on the development of overweight children. An overview]. / Einfluss des Konsumverhaltens auf die Entwicklung von Ubergewicht bei Kindern. Ein Uberblick.

The goal of this article is to provide an overview of internal and external factors influencing childhood obesity. Overweight and obese children are more likely to become overweight and obese adults with the well-known negative psychological, social, and economic consequences. Politics and research are searching for efficient prevention and intervention strategies. Consumer research helps to better understand the underlying mechanisms and feedback loops. Increasingly, children's complex and multilayered "obesogenic" environment is held responsible for the increasing number of overweight children. Based on an ecological model, the paper explores the scientific evidence of these environmental factors on an individual, an interpersonal (i.e., family, peers), as well as on a community level (i.e., the physical environment). Furthermore, it looks at societal factors, such as media influence, advertising, product offers, and consumer policies. It concludes that access, affordability, and availability of healthy diets and lifestyles are crucial factors to develop and sustain healthy lifestyles. Implications for consumer and corporate policy are drawn.

The Neanderthalian molar from Hunas, Germany.

In this paper, we present a well-preserved isolated human molar found in 1986 in the Hunas cave ruin, south-east Bavaria. The tooth was located at the bottom of layer F2, which belongs to a long stratigraphic sequence comprising faunal remains as well as archaeological levels (Mousterian). A stalagmite from layer P at the base of the stratigraphic sequence was recently dated to 79.373+/-8.237 ka (base) and 76.872+/-9.686 ka (tip) by TIMS-U/Th (Stanford University). We identified the tooth as a right (possibly third) mandibular molar. Characteristic parameters such as crown and root morphology, fissure pattern, enamel thickness, occlusal and interproximal wear, dental dimensions and indices, and radiological features indicate that the Hunas molar represents the tooth of a Neanderthal. This is corroborated by both the palaeontological and archaeological findings (Mousterian) of layer F2.

Clustering of lifestyle behaviours and relation to body composition in European children. The IDEFICS study.

BACKGROUND: Dietary patterns, physical activity (PA) and sedentary behaviours are some of the main behavioural determinants of obesity; their combined influence in children has been addressed in a limited number of studies. SUBJECTS/METHODS: Children (16,228) aged 2-9 years old from eight European countries participated in the baseline survey of the IDEFICS study. A subsample of 11,674 children (50.8% males) were included in the present study. Children's food and beverage consumption (fruit and vegetables (F&V) and sugar-sweetened beverages (SSBs)), PA and sedentary behaviours were assessed via parental questionnaires. Sex-specific cluster analysis was applied to identify behavioural clusters. Analysis of covariance and logistic regression were applied to examine the association between behavioural clusters and body composition indicators (BCIs). RESULTS: Six behavioural clusters were identified (C1-C6) both in boys and girls. In both sexes, clusters characterised by high level of PA (C1 and C3) included a large proportion of older children, whereas clusters characterised by low SSB consumption (C5 and C6) included a large proportion of younger children. Significant associations between derived clusters and BCI were observed only in boys; those boys in the cluster with the highest time spent in sedentary activities and low PA had increased odds of having a body mass index z-score (odds ratio (OR)=1.33; 95% confidence interval (CI)=(1.01, 1.74)) and a waist circumference z-score (OR=1.41; 95%CI=(1.06, 1.86)) greater than one. CONCLUSION: Clusters characterised by high sedentary behaviour, low F&V and SSB consumption and low PA turned out to be the most obesogenic factors in this sample of European children.

Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study.

BACKGROUND: The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. METHODS: Pre-intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese. RESULTS: Adherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal-weight/thin children (12.9%) CONCLUSION: The selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep.

Young children's screen activities, sweet drink consumption and anthropometry: results from a prospective European study.

BACKGROUND/OBJECTIVES: This longitudinal study describes the relationship between young children's screen time, dietary habits and anthropometric measures. The hypothesis was that television viewing and other screen activities at baseline result in increased consumption of sugar-sweetened beverages (SSB) and increased BMI, BMI z-score and waist to height ratio (WHtR) two years later. A second hypothesis was that SSB consumption mediates the association between the screen activities and changes in the anthropometric measures. SUBJECTS/METHODS: The study is a part of the prospective cohort study IDEFICS ("Identification and prevention of dietary and lifestyle-induced health effects in children and infants"), investigating diet, lifestyle and social determinants of obesity in 2 to 9-year-olds in eight European countries (baseline n=16,225, two-year follow-up; n=11,038). Anthropometry was objectively measured, and behaviours were parent-reported. RESULTS: The main hypothesis was supported, but the second hypothesis was not confirmed. The odds ratio of being in the highest quintile of % change in WHtR was 1.26 (95% CI: 1.17-1.36) and in BMI 1.22 (95% CI: 1.13-1.31), for each hour per day watching television. The odds ratio of having increased SSB consumption was 1.19 (95% CI: 1.09-1.29) for each hour per day watching TV. The associations for total screen time were slightly weaker. CONCLUSIONS: The results indicate substantial effects of TV viewing and other screen activities for young children, both on their consumption of sugary drinks and on an increase in BMI and central obesity. Our findings suggest that television viewing seems to have a stronger effect on food habits and anthropometry than other screen activities in this age group.

Country-specific dietary patterns and associations with socioeconomic status in European children: the IDEFICS study.

BACKGROUND/OBJECTIVES: Children from lower socioeconomic status (SES) may be at higher risk of unhealthy eating. We described country-specific dietary patterns among children aged 2-9 years from eight European countries participating in the IDEFICS study and assessed the association of dietary patterns with an additive SES indicator. SUBJECTS/METHODS: Children aged 2-9 years from eight European countries were recruited in 2007-2008. Principal component analysis was applied to identify dietary country-specific patterns. Linear regression analyses were applied to assess their association with SES. RESULTS: Two to four dietary patterns were identified in the participating regions. The existence of a 'processed' pattern was found in the eight regions. Also, a 'healthy' pattern was identified in seven of the eight regions. In addition, region-specific patterns were identified, reflecting the existing gastronomic and cultural differences in Europe. The 'processed' pattern was significantly inversely associated with the SES additive indicator in all countries except Sweden, whereas the 'healthy' pattern was positively associated with SES in the Belgian, Estonian, German and Hungarian regions, but was not significant in the Italian, Spanish and Swedish regions. CONCLUSIONS: A 'processed' pattern and a 'healthy' pattern were found in most of the participating countries in the IDEFICS study, with comparable food item profiles. The results showed a strong inverse association of SES with the 'processed' pattern, suggesting that children of parents with lower SES may be at higher risk of unhealthy eating. Therefore, special focus should be given to parents and their children from lower SES levels when developing healthy eating promotion strategies.

Clustering of multiple lifestyle behaviours and its association to cardiovascular risk factors in children: the IDEFICS study.

BACKGROUND/OBJECTIVES: Individual lifestyle behaviours have independently been associated with cardiovascular diseases (CVD) risk factors in children. This study aimed to identify clustered lifestyle behaviours (dietary, physical activity (PA) and sedentary indicators) and to examine their association with CVD risk factors in children aged 2-9 years. SUBJECTS/METHODS: Participants included 4619 children (51.6% boys) from eight European countries participating in the IDEFICS cross-sectional baseline survey (2007-2008). Insulin resistance, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, sum of two skinfolds and systolic blood pressure (SBP) z-scores were summed to compute a CVD risk score. Cluster analyses stratified by sex and age groups (2 to <6 years; 6-9 years) were performed using parental-reported data on fruit, vegetables and sugar-sweetened beverages (SSB) consumption, PA performance and television video/DVD viewing. RESULTS: Five clusters were identified. Associations between CVD risk factors and score, and clusters were obtained by multiple linear regression using cluster 5 ('low beverages consumption and low sedentary') as the reference cluster. SBP was positively associated with clusters 1 ('physically active'; ß=1.34; 95% confidence interval (CI): 0.02, 2.67), 2 ('sedentary'; ß=1.84; 95% CI: 0.57, 3.11), 3 ('physically active and sedentary'; ß=1.45; 95% CI: 0.15, 2.75) and 4 ('healthy diet'; ß=1.83; 95% CI: 0.50, 3.17) in older boys. A positive association was observed between CVD risk score and clusters 2 (ß=0.60; 95% CI: 0.20, 1.01), 3 (ß=0.55; 95% CI: 0.14, 0.97) and 4 (ß=0.60, 95% CI: 0.18, 1.02) in older boys. CONCLUSIONS: Low television/video/DVD viewing levels and low SSB consumption may result in a healthier CVD profile rather than having a diet rich in fruits and vegetables or being physically active in (pre-)school children.

Parental perceptions of and concerns about child's body weight in eight European countries--the IDEFICS study.

OBJECTIVES: To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort. DESIGN: Cross-sectional multi-centre study in eight European countries. PARTICIPANTS: 16,220 children, ages 2-9 years. METHODS: Parents completed a questionnaire regarding children's health and weight and concern about overweight and underweight. Objective children's weight categories from the International Obesity Task Force were used. Logistic regression models were utilized to identify predictors of accurate weight perception. RESULTS: Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, with important exceptions. About one-third of the total indicated concern about underweight, paradoxically most often parents of children in the overweight or obesity categories. In 63%, parents of children in the overweight category marked 'proper weight'. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] = 7.2, 95% confidence interval [CI] 6.1-8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3-6.0) in Northern Europe and 3.4 (95% CI 2.7-4.2) in Central Europe. CONCLUSION: Parents of children categorized as being overweight or obese systematically underestimated weight. Parents differed regionally regarding accurate weight perception and concern about overweight and underweight.

Overweight in singletons compared to children with siblings: the IDEFICS study.

The aim of this study was to compare the prevalence of overweight in only children to those with siblings and to explore potential behavioral mediating factors. This study relies upon cross-sectional data collected at survey centers in eight European countries participating in Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS). The present analysis is based on measured anthropometry and parent or guardian-reported socio-demographic characteristics. Subjects include 12 720 children aged 2-9 years for whom number of siblings was known. Singletons were more likely (odds ratio 1.52, 95% confidence interval (CI):1.34-1.72) to be overweight than their peers with siblings when controlling for factors related to childhood overweight, including survey country, parental education, parental weight, maternal age, child's age, birth weight and gender. The three southernmost countries have over threefold risk of overweight, dominated by Italy, compared with the north-central countries, which is not explained by the prevalence of singleton children. The excess risk of overweight among children without siblings was robustly observed even when considering behavioral mediating factors (playtime, screen time per day, dietary propensities for sugar or fat, parental attitudes towards food rewards and television in the child's bedroom). Among singletons aged 6-9 years, the excess risk of overweight was 1.70 (95% CI: 1.44-2.01) compared with 1.32 (95% CI: 1.10-1.60) in younger singletons.