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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.

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.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.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%)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.

The aim of this cross-sectional anthropometric study was to determine the age-related changes in the facial framework during adulthood in healthy white North Americans of European ancestry (261 male subjects and 339 female subjects). Five measurements, four horizontal and one vertical, defining the framework were taken from the skin and bony surface of the face in the maturation period (16-20 years) and in 10-year age categories of adulthood (21-90 years). As well, the thickness of the soft-tissue cover between these two anatomical levels was measured. The categories between 21 and 40 years represented early adulthood, those between 41 and 70 years represented middle adulthood, and those between 71 and 90 years represented late adulthood. The forehead width in both sexes increased significantly on the skin and bony surface from the maturation period to early adulthood. In middle adulthood, the changes were significant only sporadically. In late adulthood, the upper and lower jaw showed a harmonious change with age, mostly increasing on both the skin and bony surface. The face width proved to be the most stable measurement and had the thinnest soft-tissue cover. No consistent pattern emerged during adulthood in increases or decreases within the facial framework; however, an unexpected harmony was noted between the values of the measurements in early and late adulthood in both sexes on both the skin and bony surface. The thickness of the soft-tissue cover at the bony landmarks was greatest in the midface, with a moderately decreasing tendency in both sexes. In the lower jaw, the soft tissue showed significant increases in thickness in early adulthood and moderate to large decreases in late adulthood. Anthropometric analysis of the facial framework in adulthood marks only the first step in establishing the morphological changes of the aging face. Quantitative evaluation of changes within the facial framework of the aging population must be carried out in more detail. Increased worldwide migration results in a mixing of people of various racial/ethnic origins and necessitates a general anthropometric analysis of the aging face to provide more reliable guidelines for therapy.

The objective of this paper is to investigate differences in diets of families in intervention versus control communities 5 years after the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants intervention ended.Altogether, 4,691 families from the I.Family study with at least one participating parent and one child are included in this analysis. Diet quality indicators, defined as propensities to consume fat, sugar, water and fruit and vegetables, are calculated from a 59-item food frequency questionnaire. Multilevel linear models with random intercepts for study centre are used to determine whether mean diet indicators, calculated at the family level, differed as a function of previous exposure to the intervention.Families in the intervention communities reported a significantly lower sugar propensity (19.8% vs. 20.7% of total food items, p 0.01) and a higher water propensity (47.3% vs. 46.0% of total beverages, p 0.05) compared with families in the control communities, while fat and fruit and vegetables propensities were similar. No significant diet differences between intervention and control children were present at the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants baseline.This result indicates better diet quality in intervention families, which was not present in children when their diets were assessed before the intervention, and gives some cause for optimism regarding the sustainability of some aspects of the diet intervention.

This paper reports on the effectiveness of the prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) intervention on objectively measured physical activity (PA) and sedentary time (ST) in 2- to 9.9-year-old European boys and girls.The intervention was evaluated after 2 years through a non-randomized cluster-controlled trial in eight European countries (one control and one intervention community per country). All children in the intervention group received a culturally adapted childhood obesity prevention programme through the community, schools/kindergartens and family. A random sub-sample of children participating in the IDEFICS study wore an accelerometer at baseline and follow-up for at least 3 days (n = 9,184). Of this sample, 81% provided valid accelerometer data at baseline (n = 7,413; 51% boys; 6.21 ± 1.76 years; boys: 617 ± 170 cpm day(-1) ; girls 556 ± 156 cpm day(-1) ) and 3,010 children provided valid accelerometer data at baseline and during the follow-up survey 2 years later.In boys and girls, no significant differences in PA and ST were found between intervention and control groups over 2 years. Strong temporal effects were found in the total sample of boys and girls: the percentage of time spent in light PA per day decreased by 4 percentage points in both boys and girls between baseline and follow-up (both: p 0.001), while time spent in ST per day increased by 4 percentage points in both sexes over time (both: p 0.001). Percentage of time spent in moderate-to-vigorous PA per day remained stable over time in boys and girls.Despite the socio-ecological approach and implementation of a culturally adapted intervention in each country, no effects of the IDEFICS intervention were found on children's objectively measured PA and ST. Behavioural interventions for children may need to enhance specificity and intensity at the family level using other behaviour change techniques and more direct strategies to reach parents.

According to recent findings, short sleep duration is associated with overweight in children. However, primary prevention efforts aimed at achieving adequate sleep among children are scarce. Therefore, the 'Identification and prevention of Dietary-induced and lifestyle-induced health EFfects In Children and infantS' (IDEFICS) study implemented a multilevel intervention that included sleep duration as a key behavioural target. The aim of this study is to evaluate sleep duration among children participating in the IDEFICS study.The IDEFICS nocturnal sleep intervention was included as part of stress reduction educational messages aimed at parents and children. Sleep was assessed by a parental 24-h recall (only weekdays; n = 8,543) and by a diary (weekdays and weekends separately; n = 4,150). Mixed linear models tested the intervention effect on sleep duration change between baseline when children were 2-9.9 years of age (2007/2008) and follow-up (2009/2010). Logistic mix models were used to study the intervention effect on the presence of TV in the children's bedroom (one of the intervention messages; n = 8,668). Additionally, parents provided qualitative data regarding exposure to the intervention.About 51.1% of the parents in the intervention regions reported awareness of the sleep intervention. A small intervention effect was seen on weeknight sleep duration in that the decrease in sleep duration over 2 years was smaller in the intervention (15 min) as compared with control regions (19 min) (p = 0.044). There was no overall intervention effect on weekend sleep duration or on the presence of a TV in the bedroom. A small significant time effect between baseline and follow-up was found on bedroom TV presence depending on self-reported intervention exposure (3% increase in TV presence in exposed versus 6.6% increase in non-exposed). Children without a TV in the bedroom had longer nocturnal sleep duration.The sleep component of the intervention did not lead to clinically relevant changes in sleep duration. Future interventions aimed at young children's sleep duration could benefit from more specific and intense messaging than that found in the IDEFICS intervention. Future research should use objective measures of sleep duration as well as intermediate outcomes (sleep knowledge, sleep environment and sleep practices).

The objective of this paper is to evaluate the behavioural effects, as reported by the parents of the participating boys and girls, of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) intervention.The effectiveness of the IDEFICS intervention was evaluated through a cluster-controlled trial in eight European countries (control and intervention communities in each country) including more than 16,000 children. The 2- to 9.9-year-old children in the intervention group were exposed to a culturally adapted intervention that aimed to prevent childhood obesity through the community, schools/kindergartens and family. Parents completed questionnaires to measure water, soft drink and fruit juice intake; fruit and vegetable intake; daily TV viewing and other sedentary behaviours; daily physical activity levels and strengthening of the parent-child relationships at baseline and follow-up (2 years later). Mixed models with an additional random effect for country were used to account for the clustered study design, and results were stratified by sex.The pan-European analysis revealed no significant time by condition interaction effects, neither for boys nor girls, i.e. the analysis revealed no intervention effects on the behaviours of the IDEFICS children as reported by their parents (F = 0.0 to 3.3, all p 0.05). Also very few significances were found in the country-specific analyses. Positive intervention effects were only found for sport club participation in Swedish boys, for screen time in weekends for Spanish boys and for TV viewing in Belgian girls.Although no expected intervention effects as reported by the parents on diet, physical activity and sedentary behaviours could be shown for the overall IDEFICS cohort, a few favourable intervention effects were found on specific behaviours in some individual countries. More in-depth analyses of the process evaluation data are needed to obtain more insight into the relationship between the level of exposure to the intervention and its effect.

OBJECTIVES: To describe energy density (ED; kcal g(-1)) of dietary intake of European children. METHODS: From 16 228 children who participated in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) baseline examination, 8551 children with 24-h dietary recalls (24-HDR), with plausible reported energy intakes and complete covariate information were included in the present analysis. ED was calculated using two methods: (1) ED including solid foods (EDF) and (2) ED including solid foods and energy-containing beverages (EDF&B). Beverage energy was calculated in kcal per day. Dietary characteristics and body mass index (BMI) z-score of children aged 2 to 75th percentile. Standardised regression coefficients were estimated to assess the association between dietary characteristics, BMI z-score and ED of the diet. RESULTS: Children with low EDF and EDF&B diets consumed less energy but higher quantity of food and beverages than children with high EDF and EDF&B diets. Consumption of caloric beverages decreased with increasing EDF&B of the diet owing to the relatively low ED of the beverages, in relation to solid foods. Generally, children with low EDF and EDF&B diets showed healthier food choices than peers with higher EDF and EDF&B diets. In this sample, EDF and EDF&B were not associated with BMI z-score. CONCLUSION: Health promotion strategies should proclaim lower ED diets by means of foods with high water and low fat content and mainly fruit and vegetable components. Excluding caloric beverages from EDF calculation is a useful method to avoid misinterpretation of true exposure to a high energy dense diet. We recommend excluding caloric beverages from EDF calculation when investigating the effect of ED on a certain (health) outcome. CC BY-NC-ND 4.0Group Author(s): IDEFICS ConsortiumCorrespondence: Dr A Hebestreit, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstr. 30, D-28359 Bremen, Germany. E-mail: hebestr@bips.uni-bremen.de

To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort.Cross-sectional multi-centre study in eight European countries.16,220 children, ages 2-9 years.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.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.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.

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 protocol. 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.To assess the association between different macro- and micro-level socioeconomic factors and childhood overweight.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.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.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.

The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

The authors give a sketch about the "Körmend Growth Study" which is series of cross-sectional growth studies, carried out in Körmend, a small town in Western Hungary. The first investigation was carried out in 1958 (K-58) and it has been repeated every ten years (K-68, K-78, K-88, and K-98). All 3-18 year-old healthy boys and girls in nurseries and schools in Körmend were involved in the study. Twenty-three body measurements were taken. This paper focuses on changes in height, weight, and BMI. Means of these two body measurements show an increase from time to time (as a phenomenon of positive secular trend), however, the secular trend for increasing height and weight is declining. BMI follows a similar pattern.

The aim of this study was to estimate the fatness level of Budapest children and youth in different ways and to compare these estimations using a large representative sample. Eighteen body measurements were taken on 2606 healthy boys and 2471 healthy girls aged between 3 and 18 years. About 20% of this sample was measured by the Futrex 5000A near infrared (NIR) spectrophotometer to assess the body fat percent (data of 419 boys and 462 girls aged between 5 and 18 years were analysed). Triceps skinfold thickness (TSF), sum of triceps, medial calf, subscapular and suprailiac skinfold thicknesses (SFS), body fat percent estimated according to Slaughter et al. (%BF), BMI (calculated from height and weight) and body fat percent assessed by NIR-method (NIR%BF) were compared. chi 2 tests of independence show significant connections among the distributions ranged by the five fatness indicators. However, correlation coefficients and standard errors indicate that strong relationships are only among the assessments based on skinfold thicknesses (r = 0.92-0.97, SEE = 1.8-2.6%). BMI and NIR%BF assess body fatness differently compared to skinfold thicknesses: r-values are moderate and SEE-values are relatively large (r = 0.59-0.87, SEE = 1.9-4.7%). These findings can be seen in both the boys and the girls. NIR%BF comparing to %BF significantly overpredicts body fat percent in the boys and significantly underpredicts it in the girls. BMI, height and weight are not in significant correlation with NIR%BF in the boys but there are moderate correlations in the girls. Our suggestion is that more research is needed with the use of NIR-method in children and adolescents, and it is necessary to refine prediction equations taking into consideration very carefully sex sand age differences.

A review is given on the secular trend of the somatic development, on its part-phenomena and on the mutual interest of the human biology as well as the pediatric practice. The author presents two example of a positive secular trend in Hungary concerning the growth of height and the maturation in girls, respectively. This last one, however, shows also a negative tendency in the last decades.

Anthropometric and cytogenetic investigations were carried out in 32 patients with streak gonads. The physique of the patients was delineated according to their chromosomal complements. For the possible localization of the determinants of the X chromosome for the physique the following conclusions were drawn. 1. For normal height both the short and the long arm of the X chromosome are essential. 2. The short arm of the X chromosome contains determinants that, if deleted, result in a high weight-to-height ration, i.e., proportionally heavier weight. The weight-to-height ratio is also shifted to the left in deleted Xq cases, but to a lesser extent. 3. Determinants are present in both the short and the long arms of the X chromosomes, which are involved in the proportional development of the ratio of the limbs to trunk. In all deleted-X cases the limbs were shorter. 4. Duplication of the long arm of the X chromosome does not compensate for loss of the short arm.