BACKGROUND: Visceral adipose tissue is associated with increased risk for cardiovascular disease risk factors and morbidity from cardiovascular diseases. Waist measurement and waist-to-height ratio ...(WHtR) have been used as proxy measures of visceral adipose tissue, mainly in adults. OBJECTIVE: To validate body mass index (BMI), waist circumference and WHtR as predictors for the presence of cardiovascular disease risk factors in children of Greek-Cypriot origin. SUBJECTS AND METHODS: A total of 1037 boys and 950 girls with mean age 11.4 +/- 0.4 y were evaluated. Dependent variables for the study were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and systolic (SBP) and diastolic (DBP) blood pressure. RESULTS: When children were divided into two groups according to the 75th percentile for BMI, waist circumference and WHtR, all dependent variables had higher mean values in the highest percentile groups in WHtR groups and almost all variables in BMI and waist circumference groups. Adjusted odds ratios for predicting pathological values of cardiovascular disease risk factors were slightly higher for the highest WHtR group for predicting lipid and lipoprotein pathological values and for the highest BMI groups in predicting high blood pressure measurement. Using stepwise multiple regression analysis to explain the variance of the dependent variables, waist circumference was the most significant predictor for all variables both for boys and girls, whereas BMI had the lowest predictive value for the detection of cardiovascular disease risk factors. CONCLUSION: Waist circumference and WHtR are better predictors of cardiovascular disease risk factors in children than BMI. Further studies are necessary to determine the cutoff points for these indices for an accurate prediction of risk factors.
Measurement of cholesterol and triglyceride (TG) fractions in blood has become standard practice in the early detection of atherosclerotic disease pathways. Considerable attention is given nowadays ...to the presence of these risk factors in children and to start preventive campaigns early in life. In this context, it is imperative to have valid comparative frameworks for interpretation of lipid levels. The aim of this study is to present sex- and age-specific reference values on blood lipid levels in European children aged 2.0-10.9 years.
Fasting blood was obtained via either venipuncture or capillary sampling. In 13,579 European non-obese children (50.3% boys), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), TG and TC/HDL-C ratio levels were measured with a point-of-care analyser (Cholestech). Sex- and age-specific reference values were computed with the GAMLSS method with the statistical software R.
Reference curves and 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile values are presented. HDL-C showed a positive trend with age, from 2 years onwards, but was relatively stable above the age of 7. For LDL-C and TC, linear but small age-related trends were seen. The TC/HDL-C values showed a gradual negative trend from the age of 2 up to 6 and were relatively stable afterwards. For TG, no age trend was found (P=0.285). Boys had higher mean HDL-C values than girls (1.414 vs 1.368 mmol l(-1)), and lower TC, LDL-C, TC/HDL-C and TG values (3.981 vs 4.087 mmol l(-1); 2.297 vs 2.435 mmol l(-1); 2.84 vs 3.01mmol l(-1); and 0.509 vs 0.542 mmol l(-1), respectively).
These new and recent references could serve as a European orientation of blood lipid values in children in the context of standard medical practice and for the purpose of public health screening.
Purpose
The aim of this study was to investigate the associations between proxy-reported energy intake, daily food intake and energy density of foods and body mass index (BMI)
z
-score in ...2–9-year-old European children.
Methods
From 16,225 children who participated in the identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) baseline examination, 9,782 children with 24-h proxy dietary information and complete covariate information were included in the analysis. Participating children were classified according to adapted Goldberg cutoffs: underreports, plausible energy reports and overreports. Energy intake, daily food intake and energy density of foods excluding noncaloric beverages were calculated for all eating occasions. Effect of energy intake, daily food intake and energy density of foods on BMI
z
-score was investigated using multilevel regression models in the full sample and subsample of plausible energy reports. Exposure variables were included separately; daily food intake and energy intake were addressed in a combined model to check for interactions.
Results
In the group of plausible energy reports (
N
= 8,544), energy intake and daily food intake were significantly positively associated with BMI
z
-score. Energy density of foods was not associated with BMI
z
-score. In the model including energy intake, food intake and an interaction term, only energy intake showed a significantly positive effect on BMI
z
-score. In the full sample (
N
= 9,782), only energy intake was significantly but negatively associated with BMI
z
-score.
Conclusion
Proxy-reporters are subject to misreporting, especially for children in the higher BMI levels. Energy intake is a more important predictor of unhealthy weight development in children than daily food intake.
BACKGROUND/OBJECTIVES: Childhood obesity is a major public health concern but evidence‐based approaches to tackle this epidemic sustainably are still lacking. 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. Here, we report on the effects of the IDEFICS intervention on indicators of body fatness. SUBJECTS/METHODS: The intervention modules addressed the community, school and parental level, focusing on diet, physical activity and stress‐related lifestyle factors. A cohort of 16,228 children aged 2–9.9 years – about 2000 per country – was equally divided over intervention and control regions. (Participating countries were Sweden, Germany, Estonia, Hungary, Cyprus, Italy, Spain and Belgium.) We compared the prevalence of overweight/obesity and mean values of body mass index z‐score, per cent body fat and waist‐to‐height ratio over 2 years of follow‐up. Mixed models adjusting for age and socioeconomic status of the parents and with an additional random effect for country accounted for the clustered study design. RESULTS: The prevalence of overweight and obesity increased in both the intervention and control group from 18.0% at baseline to 22.9% at follow‐up in the control group and from 19.0% to 23.6% in the intervention group. The difference in changes between control and intervention was not statistically significant. For the cohort as a whole, the changes in indicators of body fatness did not show any clinically relevant differences between the intervention and control groups. Changes in favour of intervention treatment in some indicators were counterbalanced by changes in favour of the control group in some other indicators. CONCLUSIONS: Over the 2‐year‐observation period, the IDEFICS primary prevention programme for childhood obesity has not been successful in reducing the prevalence of overweight and obesity nor in improving indicators of body fatness in the target population as a whole.
Longitudinal studies investigating dietary patterns (DPs) and their association with childhood overweight/obesity are lacking in Europe. We identified DPs and investigated their association with ...overweight/obesity and changes in body mass index (BMI) in a cohort of European children.
Children aged 2-10 from eight European countries were recruited in 2007-2008. Food frequency questionnaires were collected from 14 989 children. BMI and BMI z-scores were derived from height and weight and were used to identify overweight/obese children. After 2 years (mean), anthropometric measurements were repeated in 9427 children. Principal component analysis was used to identify DPs. Simplified DPs (SDPs) were derived from DPs. Adjusted odds ratios (ORs) for overweight/obesity with increasing DP intake were estimated using multilevel logistic regression. Associations of BMI change with DP and SDP were assessed by multilevel mixed regression. Models were adjusted for baseline BMI, age, sex, physical activity and family income.
Four DPs were identified that explained 25% of food intake variance: snacking, sweet and fat, vegetables and wholemeal, and protein and water. After 2 years, 849(9%) children became overweight/obese. Children in the highest vegetables and wholemeal tertile had lower risk of becoming overweight/obese (OR: 0.69, 95% confidence intervals (CIs): 0.54-0.88). Children in the highest SDP tertile of vegetables and wholemeal had similarly lower risk of becoming overweight/obese (OR: 0.64, 95% CIs: 0.51-0.82), and their BMI increased by 0.7 kg/m(2) over the study period-significantly less than the increase in the lowest tertile (0.84 kg/m(2)).
Our findings suggest that promoting a diet rich in vegetables and wholemeal cereals may counteract overweight/obesity in children.
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.
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.
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.
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.
Despite documented benefits of a Mediterranean-like dietary pattern, there is a lack of knowledge about how children from different European countries compare with each other in relation to the ...adherence to this pattern. In response to this need, we calculated the Mediterranean diet score (MDS) in 2-9-year-old children from the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) eight-country study.
Using 24 h dietary recall data obtained during the IDEFICS study (n=7940), an MDS score was calculated based on the age- and sex-specific population median intakes of six food groups (vegetables and legumes, fruit and nuts, cereal grains and potatoes, meat products and dairy products) and the ratio of unsaturated to saturated fats. For fish and seafood, which was consumed by 10% of the population, one point was given to consumers. The percentages of children with high MDS levels (>3) were calculated and stratified by sex, age and by having at least one migrant parent or both native parents. Demographic (sex and age) and socioeconomic characteristics (parental education and income) of children showing high (>3) vs low (⩽3) MDS levels were examined.
The highest prevalence of children with MDS>3 was found among the Italian pre-school boys (55.9%) and the lowest among the Spanish school-aged girls (26.0%). Higher adherence to a Mediterranean-like dietary pattern was not associated with living in a Mediterranean country or in a highly educated or high-income family, although with some exceptions. Differences in adherence between boys and girls or age groups varied between countries without any general pattern.
With the exception of Italian pre-schoolers, similar adherence levels to a Mediterranean-like dietary pattern have been observed among European children.
To assess the association of baseline cardiorespiratory fitness (CRF) with incidence of overweight over a 4.6‐year period in adolescence. In a cohort of 4878 adolescents, we assessed body mass index ...in years 2001–2003 and 2007. CRF was assessed at baseline as maximal oxygen consumption (VO2max, mL/kg/min) using the 20‐m shuttle run test and was examined against incidence of overweight at follow‐up. Estimated VO2max at baseline was higher in males than in females, P < 0.001, and was lower in overweight and obese than in non‐overweight subjects. The incidence of overweight at follow‐up among non‐overweight participants at baseline was 15.5% 95% confidence interval (CI) 13.7% to 17.3% in males and 5.6% (95% CI 4.9% to 7.0%) in females, P < 0.001. Adjusted odds ratio for incidence of overweight in participants in the fourth quartile of VO2max was 0.40 (95%CI 0.26 to 0.61) in males and 0.57 (95% CI 0.33 to 0.99) in females in comparison with participants in the first quartiles of VO2max. Incidence of overweight was three times more frequent in males than in females. Among non‐overweight at baseline, high fitness levels were inversely associated with incidence of overweight at follow‐up, suggesting that interventions aiming to increase CRF in early childhood might help reverse increasing trends in obesity.
Summary
What is already known about this subject
Overweight and obesity can be linked to different parental socioeconomic factors already in very young children.
In Western developed countries, the ...association of childhood overweight and obesity and parental socioeconomic status shows a negative gradient.
Ambiguous results have been obtained regarding the association between socioeconomic factors and childhood overweight and obesity in different countries and over time.
What this study adds
European regions show heterogeneous associations between socioeconomic factors and overweight and obesity in a multi‐centre study with highly standardized study protoco.
The strength of association between SES and overweight and obesity varies across European regions.
In our study, the SES gradient is correlated with the regional mean income and the country‐specific Human development index indicating a strong influence not only of the family but also of region and country on the overweight and obesity prevalence.
Objective
To assess the association between different macro‐ and micro‐level socioeconomic factors and childhood overweight.
Methods
Data from the IDEFICS baseline survey is used to investigate the cross‐sectional association between socioeconomic factors, like socioeconomic status (SES), and the prevalence of childhood overweight. Differences and similarities regarding this relationship in eight European regions (located in Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden) are explored. 11 994 children (50.9% boys, 49.1% girls) and their parents were included in the analyses.
Results
In five of the eight investigated regions (in Belgium, Estonia, Germany, Spain and Sweden), the prevalence of childhood overweight followed an inverse SES gradient. In the other three regions (in Cyprus, Hungary and Italy), no association between SES and childhood overweight was found. The SES‐overweight association in a region was best explained by the country‐specific human development index and the centre‐specific mean income. For the investigated association between other socioeconomic factors and overweight, no clear pattern could be found in the different regions.
Conclusion
The association between socioeconomic factors and childhood overweight was shown to be heterogeneous across different European regions. Further research on nationwide European data is needed to confirm the results and to identify target groups for prevention.
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