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.
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.
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.
This large-scale European effort is expected to contribute significantly to the understanding of this major public health challenge.
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.
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.
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).
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.
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.
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.
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'; β=1.34; 95% confidence interval (CI): 0.02, 2.67), 2 ('sedentary'; β=1.84; 95% CI: 0.57, 3.11), 3 ('physically active and sedentary'; β=1.45; 95% CI: 0.15, 2.75) and 4 ('healthy diet'; β=1.83; 95% CI: 0.50, 3.17) in older boys. A positive association was observed between CVD risk score and clusters 2 (β=0.60; 95% CI: 0.20, 1.01), 3 (β=0.55; 95% CI: 0.14, 0.97) and 4 (β=0.60, 95% CI: 0.18, 1.02) in older boys.
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.
BACKGROUND: The aim of this study was to explore whether the IDEFICS intervention had a differential effect on 11,041 children's weight trajectories depending on their baseline body mass index ...status. METHODS: Two subgroups of children are considered in the present analysis: those who were overweight or obese prior to the intervention and those who were neither overweight nor obese. RESULTS: Among children in all eight countries who did not have prevalent overweight or obesity (OWOB) at baseline, 2 years later, there was no significant difference between intervention and control groups in risk of having developed OWOB. However, we observed a strong regional heterogeneity, which could be attributed to the presence of one distinctly outlying country, Belgium, where the intervention group had increased risk for becoming overweight. In contrast, among the sample of children with prevalent OWOB at baseline, we observed a significantly greater probability of normalized weight status after 2 years. In other words, a protective effect against persistent OWOB was observed in children in intervention regions compared with controls, which corresponded to an adjusted odds ratio of 0.76 (95% confidence interval: 0.58, 0.98). DISCUSSION: This analysis thus provided evidence of a differential effect of the IDEFICS intervention, in which children with overweight may have benefited without having been specifically targeted. However, no overall primary preventive effect could be observed in children without initial overweight or obesity.
The environment of children has drastically changed in Europe during the last decades as reflected in unhealthy dietary habits and sedentary lifestyle. Nutrition obviously plays a part in the ...development of overweight in childhood. However, dietary factors and physical activity are also involved in the development of metabolic syndrome, type II diabetes, cardiovascular diseases, osteoporosis, and postural deformities like scoliosis, effects related in part to excessive weight gain. To stop the resulting epidemic of diet- and lifestyle-induced morbidity, efficient evidence-based approaches are needed. These issues are the focus of IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants), a five-year project proposed under the sixth EU framework. The IDEFICS consortium comprises 25 research centres and SMEs across Europe. The planned prospective study will identify risk profile inventories for children susceptible to any of these disorders with emphasis on obesity and its co-morbid conditions. Genetic and non-genetic factors, psychosocial factors and social settings will be considered. The project will devise tailored prevention strategies that are effective, easy to implement and that account for the needs of different social groups. Population-based studies will investigate the impact of sensory perception and provide results concerning internal and external triggers of food choices and children's consumer behaviour. The ethical implications of a “right not to know” of genetic factors will be addressed. We will propose knowledge-based guidelines on dietary and lifestyle activities for health promotion and disease prevention in children for health professionals, stakeholders and consumers.
The rapidly developing genotyping technology has led to the detection of many genetic factors that contribute to the pathogenesis of complex diseases. From this, the aim arose to use these results to ...offer tailored preventive measures or therapies based on an individual genetic profile. For this purpose, genetic tests are being developed that should allow us to identify individuals who belong to a high risk group with respect to a certain disease due to their genetic predisposition. Such tests are often based on known genetic risk factors that have been identified in genome-wide association studies. Typically, the effect estimates obtained from these studies are further used to construct a genetic risk measure to predict a certain phenotype. This paper describes several statistical and methodological challenges that must be coped with when establishing a genetic prediction model: Starting with the goal to obtain unbiased effect estimates to identify appropriate genetic risk predictors, genetic risk measures must be developed, and the predictive value of a new genetic test must be established. These key requirements of a statistical risk prediction in genetics will be discussed in three sections and finally discussed from a public health perspective.
Summary
What is already known about this subject
Parents of children with overweight and obesity tend to underestimate their children's weight.
Most studies show no association between parental ...education level and accurate parental perception of a child's weight category.
Studies show no consistent relationship between parental weight perception and the child's gender.
What this study adds
Parental underestimation of children's weight category for children in the overweight and obesity categories was found across eight European countries.
Regional differences indicated a more accurate parental weight perception in Northern and Central Europe.
A high proportion of parents in Southern Europe were concerned about future underweight or overweight in their children.
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.
International cohort studies Ahrens, W; Pigeot, I
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
55, Številka:
6-7
Journal Article
Recenzirano
Among observational studies, cohort studies, i.e. longitudinal observations of selected population groups, provide the highest possible evidence of a causal association between specific risk factors ...(exposure) and the occurrence of disease in populations. Besides the fact that many exposures cannot be investigated in experimental designs, cohort studies have the advantage over randomized clinical trials that they are conducted in free living populations and not in restrictive, clinical settings. In this paper we describe the aims and features of international cohorts that have been selected because of their impact, their size or their endpoints. We do not only present the study designs and survey instruments used but we also highlight some of the most important results gained by these studies. Most of these prospective studies investigated common chronic diseases in the elderly, such as cancer, diabetes, cardiovascular or neurodegenerative diseases, osteoporosis and ophthalmologic disorders. Newer cohorts and recent reassessments of existing cohorts almost always include the collection and storage of biological samples. In recent years technological developments allowed the implementation of cutting edge measurement procedures, such as imaging techniques for phenotyping. Finally, we discuss on the one hand whether these designs can be transferred to the German situation and on the other hand to what degree the results obtained from foreign cohorts can be generalized for the German population. We conclude with recommendations for future cohort studies.
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