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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. European Journal of Clinical Nutrition (2015) 69, 811-816; doi:10.1038/ejcn.2015.76; published online 3 June 2015, INTRODUCTION Changes in multiple lifestyle behaviours contributing to energy imbalance are required in successful multi-factorial approaches of obesity prevention. (1) Dietary patterns, physical activity (PA) and sedentary behaviours are some [...]

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. European Journal of Clinical Nutrition (2014) 68, 811-821;doi:10.1038/ejcn.2014.78; published online 14 May 2014, INTRODUCTION Social inequalities in health are present from childhood until adult life; socioeconomic status (SES) differences in the risk of morbidity and mortality have been well documented. (1) The burden [...]

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. European Journal of Clinical Nutrition (2014) 68, 223-228; doi: 10.1038/ejcn.2013.234; published online 20 November 2013 Keywords: Children; screen time; television; soft drinks; overweight, INTRODUCTION Childhood obesity has a complex etiology and, according to a recent review, has long-term effects into adulthood, including premature mortality and morbidity. (1) Systematic reviews (2,3) and pooled analysis [...]

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'; 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 (b = 0.60;95% CI: 0.20, 1.01), 3 (b = 0.55;95% CI: 0.14, 0.97) and 4 (β = 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. European Journal of Clinical Nutrition (2013) 67, 848-854; doi:10.1038/ejcn.2013.84; published online 1 May 2013 Keywords: cardiovascular diseases; lifestyle; diet; exercise; sedentary lifestyle; child, INTRODUCTION Increased risk of CVD is characterized by a cluster of metabolic abnormalities, such as abdominal obesity, atherogenic dyslipemia, hypertension, insulin resistance and glucose intolerance. (1) CVD remains the leading [...]

Objective: To assess the relationship between parental education level and the consumption frequency of obesity-related foods in European children.Design: The analysis was based on data from the cross-sectional baseline survey of a prospective cohort study. The effects of parental education on food consumption were explored using analysis of covariance and logistic regression.Setting: Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain.Subjects: Participants (n 14,426) of the IDEFICS baseline cohort study aged 2 to 9 years.Results: Parental education level affected the intake of obesity-related foods in children. Children in the low and medium parental education level groups had lower odds of more frequently eating low-sugar and low-fat foods (vegetables, fruits, pasta/noodles/rice and wholemeal bread) and higher odds of more frequently eating high-sugar and high-fat foods (fried potatoes, fruits with sugar and nuts, snacks/desserts and sugared beverages; P < 0.001). The largest odds ratio differences were found in the low category (reference category: high) for vegetables (OR = 0.56; 95 % CI 0.47, 0.65), fruits (OR = 0.56; 95% CI 0.48, 0.65), fruits with sugar and nuts (OR = 2.23; 95% CI 1.92, 2.59) and sugared beverages (OR = 2.01; 95% CI 1.77, 2.37).Conclusions: Low parental education level was associated with intakes of sugar-rich and fatty foods among children, while high parental education level was associated with intakes of low-sugar and low-fat foods. These findings should be taken into account in public health interventions, with more targeted policies aiming at an improvement of children's diet. [ABSTRACT FROM AUTHOR]

Unlabelled: Sleep duration has been identified as risk factor for obesity already in children. Besides investigating the role of fat mass (FM), this study addressed the question whether endocrine mechanisms act as intermediates in the association between sleep duration and overweight/obesity. Within the framework of the IDEFICS study, the present research was conducted in 609 German resident children aged 2-9 years with information on fasting insulin, C-reactive protein and cortisol levels next to anthropometric measurements and parental questionnaires. Emphasising methodological aspects, an age-specific measure of sleep duration was derived to account for alteration in sleep duration during childhood/period of growth. Multivariate linear regression and quantile regression models confirmed an inverse relationship between sleep duration and measures of overweight/obesity. The estimate for the association of sleep duration and body mass index (BMI) was approximately halved after adjustment for FM, but remained significant. The strength of this association was also markedly attenuated when adjusting for insulin mainly for the upper BMI quantiles (Q80, β = -0.36 vs. β = -0.26; Q95, β = -0.87 vs. β = -0.47). Adjustment for cortisol and CrP did not yield this attenuation.Conclusion: The inverse relationship between sleep duration and BMI is mainly explained by the association between sleep duration and FM. Insulin may explain part of this association, in particular at the upper tail of the BMI distribution. [ABSTRACT FROM AUTHOR]

Objective: To examine racial differences in breast cancer screening in an HMO that provides screening at no cost.Design: Retrospective cohort study of breast cancer screening among African-American and white women. Breast cancer screening information was extracted from computerized medical records.Setting: A large HMO in New England.Patients/participants: White and African-American women (N = 2,072) enrolled for at least 10 years in the HMO.Main Results: Primary care clinicians documented recommending a screening mammogram significantly more often for African Americans than whites (70% vs 64%; P <.001). During the 10-year period, on average, white women obtained more mammograms (4.49 vs 3.93; P <.0001) and clinical breast examinations (5.35 vs 4.92; P <.01) than African-American women. However, a woman's race was no longer a statistically significant predictor of breast cancer screening after adjustment for differences in age, estimated household income, estrogen use, and body mass index (adjusted number of mammograms, 4.47 vs 4.25, P =.17; and adjusted number of clinical breast examinations, 5.35 vs 5. 31, P =.87).Conclusions: In this HMO, African-American and white women obtained breast cancer screening at similar rates. Comparisons with national data showed much higher screening rates in this HMO for both white and African-American women. [ABSTRACT FROM AUTHOR]

The digital environment can pose health risks through exposure to unhealthy content. Yet, little is known about its relation to children's cognitive functioning. This study investigates the association between digital media (DM) exposure and children's cognitive functioning. This cross-sectional study is based on examinations of children aged 8-18 years (N = 8673) of the I.Family cohort (2013-2014). Exposure to television, computer, smartphone and internet was self-reported (hours/day). Media multitasking (MMT) was defined as simultaneous use of computers with other digital or non-screen-based activities. Standard instruments were used to assess cognitive inflexibility (score: 0-39), decision-making ability (- 100 to + 100) and impulsivity (12-48). Adjusted regression coefficients and 99.9%CIs were calculated by generalized linear mixed-effects models. In total, 3261 participants provided data for impulsivity, 3441 for cognitive inflexibility and 4046 for decision-making. Exposure to smartphones and media multitasking were positively associated with impulsivity (β smartphone  = 0.74; 99.9%CI = 0.42-1.07; β MMT  = 0.73; 99.9%CI = 0.35-1.12) and cognitive inflexibility (β smartphone  = 0.32; 99.9%CI = -0.02-0.66; β MMT  = 0.39; 99.9%CI = 0.01-0.77) while being inversely associated with decision-making ability. Extensive smartphone/internet exposure combined with low computer/medium TV exposure was associated with higher impulsivity and cognitive inflexibility scores, especially in girls. DM exposure is adversely associated with cognitive functioning in children and adolescents. Children require protection against the likely adverse impact of digital environment., (© 2023. The Author(s).)

Detection of melanocytes serves as a critical prerequisite in assessing melanocytic growth patterns when diagnosing melanoma and its precursor lesions on skin biopsy specimens. However, this detection is challenging due to the visual similarity of melanocytes to other cells in routine Hematoxylin and Eosin (H&E) stained images, leading to the failure of current nuclei detection methods. Stains such as Sox10 can mark melanocytes, but they require an additional step and expense and thus are not regularly used in clinical practice. To address these limitations, we introduce VSGD-Net, a novel detection network that learns melanocyte identification through virtual staining from H&E to Sox10. The method takes only routine H&E images during inference, resulting in a promising approach to support pathologists in the diagnosis of melanoma. To the best of our knowledge, this is the first study that investigates the detection problem using image synthesis features between two distinct pathology stainings. Extensive experimental results show that our proposed model outperforms state-of-the-art nuclei detection methods for melanocyte detection. The source code and pre-trained model are available at: https://github.com/kechunl/VSGD-Net.

Taxing sugar-sweetened beverages (SSB) is seen as a win-win situation for governments. It is argued that SSB taxes are relatively easy to implement from a practical perspective compared to for example other nutrition policies. However, the implementation of SSB taxation laws does not happen by itself. Therefore, this work examines implementation processes for SSB taxation in terms of (1) pre-implementation context, (2) taxation instruments used and (3) interactions in the implementation process. Ten databases and grey literature were systematically searched for studies reporting on SSB taxation implementation processes up to February 2020. All studies (N = 1248) were screened independently by two reviewers according to predefined criteria. The selection of variables to be extracted was based on the policy cycle heuristic and informed by intervention implementation research. Information on the process of implementing SSB taxation is limited. Only six cases based on three publications were identified, indicating a gap in this research area. SSB taxation implementation was accomplished by hiring a subcontractor for the implementation or using pre-existing tax collection structures. Political and public support within the implementation process seems to be supportive for the city of Berkeley and for Portugal but was not reported for the Pacific Islands. However, the existing data are very limited, and further research on SSB taxation implementation processes is needed to determine whether the aim of the policy and the envisaged outcome are linked in practice. Registration The protocol was registered with the Open Science Framework (OSF) (osf.io/7w84q/)., (© 2022. The Author(s).)

Background: Media use may influence metabolic syndrome (MetS) in children. Yet, longitudinal studies are scarce. This study aims to evaluate the longitudinal association of childhood digital media (DM) use trajectories with MetS and its components., Methods: Children from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden participating in the IDEFICS/I.Family cohort were examined at baseline (W1: 2007/2008) and then followed-up at two examination waves (W2: 2009/2010 and W3: 2013/2014). DM use (hours/day) was calculated as sum of television viewing, computer/game console and internet use. MetS z-score was calculated as sum of age- and sex-specific z-scores of four components: waist circumference, blood pressure, dyslipidemia (mean of triglycerides and HDL-cholesterol -1 ) and homeostasis model assessment for insulin resistance (HOMA-IR). Unfavorable monitoring levels of MetS and its components were identified (cut-off: ≥ 90 th percentile of each score). Children aged 2-16 years with ≥ 2 observations (W1/W2; W1/W3; W2/W3; W1/W2/W3) were eligible for the analysis. A two-step procedure was conducted: first, individual age-dependent DM trajectories were calculated using linear mixed regressions based on random intercept (hours/day) and linear slopes (hours/day/year) and used as exposure measures in association with MetS at a second step. Trajectories were further dichotomized if children increased their DM duration over time above or below the mean., Results: 10,359 children and adolescents (20,075 total observations, 50.3% females, mean age = 7.9, SD = 2.7) were included. DM exposure increased as children grew older (from 2.2 h/day at 2 years to 4.2 h/day at 16 years). Estonian children showed the steepest DM increase; Spanish children the lowest. The prevalence of MetS at last follow-up was 5.5%. Increasing media use trajectories were positively associated with z-scores of MetS (slope: β = 0.54, 95%CI = 0.20-0.88; intercept: β = 0.07, 95%CI = 0.02-0.13), and its components after adjustment for puberty, diet and other confounders. Children with increasing DM trajectories above mean had a 30% higher risk of developing MetS (slope: OR = 1.30, 95%CI = 1.04-1.62). Boys developed steeper DM use trajectories and higher risk for MetS compared to girls., Conclusions: Digital media use appears to be a risk factor for the development of MetS in children and adolescents. These results are of utmost importance for pediatricians and the development of health policies to prevent cardio-metabolic disorders later in life., Trial Registration: ISRCTN, ISRCTN62310987 . Registered 23 February 2018- retrospectively registered., (© 2021. The Author(s).)

Background: Since only few longitudinal studies with appropriate study designs investigated the relationship between objectively measured physical activity (PA) and overweight, the degree PA can prevent excess weight gain in children, remains unclear. Moreover, evidence is limited on how childhood overweight determines PA during childhood. Therefore, we analyzed longitudinal trajectories of objectively measured PA and their bi-directional association with weight trajectories of children at 2- and 6-year follow-ups., Methods: Longitudinal data of three subsequent measurements from the IDEFICS/I.Family cohort study were used to analyze the bi-directional association between moderate-to-vigorous PA (MVPA) and weight status by means of multilevel regression models. Analyses comprised 3393 (2-year follow-up) and 1899 (6-year follow-up) children aged 2-15.9 years from eight European countries with valid accelerometer data and body mass index (BMI) measurements. For categorized analyses, children's weight status was categorized as normal weight or overweight (cutoff: 90th percentile of BMI) and children's PA as (in-) sufficiently active (cutoffs: 30, 45 and 60 min of MVPA per day)., Results: Children engaging in at least 60 min MVPA daily at baseline and follow-ups had a lower odds of becoming overweight (odds ratio [OR] at 2-year follow-up: 0.546, 95% CI: 0.378, 0.789 and 6-year follow-up: 0.393, 95% CI: 0.242, 0.638), compared to less active children. Similar associations were found for 45 min MVPA daily. On the other side, children who became overweight had the lowest odds to achieve 45 or 60 min MVPA daily (ORs: 0.459 to 0.634), compared to normal weight children., Conclusions: Bi-directional associations between MVPA and weight status were observed. In summary, at least 60 min MVPA are still recommended for the prevention of childhood overweight. To prevent excess weight gain, 45 min MVPA per day also showed preventive effects., (© 2021. The Author(s).)

Digital media (DM) influences children's food choice. We aim to investigate associations between DM use and taste preferences (TP) for sweet, fatty, bitter, and salty in European children and adolescents. Individuals aged 6-17 years (N = 7094) providing cross-sectional data for DM use: television (TV), computer/game console (PC), smartphone and internet, were included. Children (6 to <12 years) and adolescents (≥12 years) completed a Food and Beverage Preference Questionnaire; scores were calculated for sweet, fatty, salty and bitter preference and categorized (high vs. low). Logistic regression was used to calculate odds ratios as association measures between DM exposure and TP. On average, individuals used media for 2.4 h/day (SD = 1.7). Increasing exposures to DM were associated positively with sweet, fatty and salty TP, while inversely with bitter preference. In female adolescents, DM exposure for >2 h/day was associated with sweet (OR = 1.27, 95% CI = 1.02-1.57) and fatty preference (OR = 1.37; 95% CI = 1.10-1.70). Internet exposure was inversely associated with bitter preference, notably in male adolescents (OR = 0.65, 95% CI = 0.50-0.84), but positively associated with salty preference (OR = 1.29, 95% CI = 1.02-1.64). DM exposure was associated with sweet, fatty, salty and bitter TP in children and adolescents, serving as the basis for future longitudinal studies to shed light on the underlying mechanism by which DM exposure may determine eating habits.

This paper presents selected highlights from the 'Engaging with society' session of EFSA's third Scientific Conference 'Science, Food and Society' (Parma, Italy, 18-21 September 2018). The social dimension for scientific advisory bodies largely concerns science communication and public engagement. The political, economic and technological transformation of contemporary societies is challenging conventional structures and approaches in these areas. The disintermediation of communication and the proliferation of misinformation, it is argued, herald the onset of the post-truth society. A better understanding of the way individuals consume information today has led to the development of tools to guide mediators such as journalists and communication specialists in countering these trends. Public engagement can reinforce confidence in regulatory bodies and potentially contribute to the quality of the scientific process. Scientific advisory bodies in Europe have created strategies and mechanisms to engage the public that are designed to increase transparency and representativeness. To be effective, several engagement mechanisms are needed, although factors such as resource constraints, institutional culture and public/stakeholder attitudes may limit their development. In conclusion, a more vigorous role for social research is needed to place scientific risk assessment within broader socio-economic and political contexts. Social science expertise can help to define more impactful public information strategies and to explore the potential opportunities that engaged stakeholders and citizens can make to sustain and strengthen regulatory science., (© 2019 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.)