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Obesity is a chronic disease, in which treatment outcomes are highly dependent on patient and family adherence to behavioural recommendations. The role of healthy eating, physical activity, medication adherence as well as adherence to pre- and post-bariatric surgery protocols are of utmost importance for long-term treatment outcomes. Even the best interventions are not likely to reach their maximum benefit without significant levels of adherence on the part of the individual and family. Traditionally, the annual meeting of the European Childhood Obesity Group (ECOG) includes an expert workshop addressing one specific topic within the field of childhood obesity. During the 30th annual meeting, hosted by the University of Pécs, Hungary, as a virtual meeting, “adherence to treatment recommendations in obesity as a chronic disease” was addressed. The discussions that developed during the workshop are summarized in the following article.

Adequate complementary feeding practices are important for short- and long-term child health. In industrialized countries, the formulation of several commercial baby foods (CBFs) and an increase in their consumption has been noticed. Aim: To update and analyze the nutritional composition of CBFs available in the Italian market. Methods: Data collection carried out in two steps (July 2018–January 2019) and updated in May–September 2021. The information on CBFs was taken from the websites of the major CBF producers available in Italy. The collected information were: Suggested initial and final age of consumption; Ingredients; Energy value; Macronutrients (protein, lipids, and carbohydrates); Fiber; Micronutrients (sodium, iron, and calcium); Presence of salt and added sugars, flavorings, and other additives. Results: Time-space for which CBFs are recommended starts too early and ends too late; protein content is adequate and even too high in some food; Amount of fats and their quality must be improved, keeping the intake of saturated fats low; Sugar content is too high in too many CBFs and salt is unnecessarily present in some of them. Finally, the texture of too many products is purée, and its use is recommended for too long, hindering the development of infants’ chewing abilities.

During the complementary feeding period, any nutritional deficiencies may negatively impact infant growth and neurodevelopment. A healthy diet containing all essential nutrients is strongly recommended by the WHO during infancy. Because vegetarian diets are becoming increasingly popular in many industrialized countries, some parents ask the pediatrician for a vegetarian diet, partially or entirely free of animal-source foods, for their children from an early age. This systematic review aims to evaluate the evidence on how vegetarian complementary feeding impacts infant growth, neurodevelopment, risk of wasted and/or stunted growth, overweight and obesity. The SR was registered with PROSPERO 2021 (CRD 42021273592). A comprehensive search strategy was adopted to search and find all relevant studies. For ethical reasons, there are no interventional studies assessing the impact of non-supplemented vegetarian/vegan diets on the physical and neurocognitive development of children, but there are numerous studies that have analyzed the effects of dietary deficiencies on individual nutrients. Based on current evidence, vegetarian and vegan diets during the complementary feeding period have not been shown to be safe, and the current best evidence suggests that the risk of critical micronutrient deficiencies or insufficiencies and growth retardation is high: they may result in significantly different outcomes in neuropsychological development and growth when compared with a healthy omnivorous diet such as the Mediterranean Diet. There are also no data documenting the protective effect of vegetarian or vegan diets against communicable diseases in children aged 6 months to 2–3 years.

Several institutions propose responsive feeding (RF) as the caregivers’ relational standard when nurturing a child, from breast/formula feeding onwards. Previous systematic reviews (SRs) on caregivers’ feeding practices (CFPs) have included studies on populations from countries with different cultures, rates of malnutrition, and incomes, whereas this SR compares different CFPs only in healthy children (4–24 months) from industrialized countries. Clinical questions were about the influence of different CFPs on several important outcomes, namely growth, overweight/obesity, risk of choking, dental caries, type 2 diabetes (DM2), and hypertension. The literature review does not support any Baby Led Weaning’s or Baby-Led Introduction to SolidS’ (BLISS) positive influence on children’s weight–length gain, nor their preventive effect on future overweight/obesity. RF-CFPs can result in adequate weight gain and a lower incidence of overweight/obesity during the first two years of life, whereas restrictive styles and coercive styles, two kinds of non-RF in CF, can have a negative effect, favoring excess weight and lower weight, respectively. Choking risk: failure to supervise a child’s meals by an adult represents the most important risk factor; no cause–effect relation between BLW/BLISS/RF/NRCF and choking could be found. Risks of DM2, hypertension, and caries: different CFPs cannot be considered as a risky or preventive factor for developing these conditions later in life.

Adequate and balanced nutrition is essential to promote optimal child growth and a long and healthy life. After breastfeeding, the second step is the introduction of complementary feeding (CF), a process that typically covers the period from 6 to 24 months of age. This process is, however, still highly controversial, as it is heavily influenced by socio-cultural choices, as well as by the availability of specific local foods, by family traditions, and pediatrician beliefs. The Società Italiana di Pediatria Preventiva e Sociale (SIPPS) together with the Federazione Italiana Medici Pediatri (FIMP), the Società Italiana per lo Sviluppo e le Origine della Salute e delle Malattie (SIDOHaD), and the Società Italiana di Nutrizione Pediatrica (SINUPE) have developed evidence-based recommendations for CF, given the importance of nutrition in the first 1000 days of life in influencing even long-term health outcomes. This paper includes 38 recommendations, all of them strictly evidence-based and overall addressed to developed countries. The recommendations in question cover several topics such as the appropriate age for the introduction of CF, the most appropriate quantitative and qualitative modalities to be chosen, and the relationship between CF and the development of Non-Communicable Diseases (NCDs) later in life.

Suboptimal nutrient quality/quantity during complementary feeding (CF) can impact negatively on infants’ healthy growth, even with adequate energy intake. CF must supplement at best human milk (HM) or formulas, which show nutritional differences. Considering this, a differentiated CF is probably advisable to correctly satisfy the different nutritional needs. To assess whether current needs at 6–24 months of age can still be met by one single CF scheme or different schemes are needed for breastfed vs. formula/cow’s milk (CM) fed infants, protein, iron and calcium intakes were assessed from daily menus using the same type and amount of solid food, leaving same amounts of HM and follow-up formula at 9 and again 18 months of age, when unmodified CM was added. Depending on the child’s age, calcium- and iron-fortified cereals or common retail foods were used. The single feeding scheme keeps protein intake low but higher than recommended, in HM-fed children while in formula/CM-fed ones, it achieves much higher protein intakes. Iron Population Recommended Intake (PRI) and calcium Adequate Intakes (AI) are met at the two ages only when a formula is used, otherwise, calcium-fortified cereals are needed. ESPGHAN statements on the futility of proposing different CF schemes according to the milk type fed do not allow to fully meet the nutritional recommendations issued by major Agencies/Organizations/Societies for all children of these age groups.

Background: Adiposity rebound (AR) refers to the second rise of the BMI curve that usually occurs physiologically between 5 and 7 years of age. AR timing has a great impact on children´s health, being the early adiposity rebound (EAR) associated with the development of metabolic disease later in life. Aim: We aimed to investigate the prevalence of EAR in a cohort of preterm newborns. Secondary outcomes evaluated if some determinants such as (1) gender (male/female), (2) type of delivery (caesarean/vaginal), (3) birth weight (SGA/NGA/LGA), (4) type of feeding (5) duration of breastfeeding, (6) timing of introduction of solid food, (7) parental education and (8) parental pre-pregnancy BMI can influence EAR in this cohort. Tertiary aim was to evaluate the prevalence of obesity or overweight at 7 years of age in children according to early versus timely AR. Methods: This is a perspective, population-based longitudinal study, where infants born preterm were evaluated at birth and at 1, 3, 6, 9, 12, 15, 18, 24 months and 3, 4, 5, 6, 7 years of gestational-corrected age. Weight and height data were analyzed, and BMI was calculated. AR was assessed in the growth trajectory in a body mass index (BMI) plot. Results: Of the 250 preterm newborns included, 100 completed the 7 years follow-up and entered in the final analysis. The prevalence of EAR in our cohort of preterm newborns was 54%. EAR was associated with being LGA at birth. No other factors were associated to EAR. Early adiposity rebounders have a significant higher BMI at 7 years compared to children with timely AR (17.2 ±2.7 vs 15.6 ± 2.05, p=0.021). No significant differences were found in the prevalence of obesity or overweight at 7 years of age in children with early or timely AR (29% vs 14% p=0.202). Conclusions: Clinical management of preterm infants should focus on reducing excess weight gain to prevent long-term metabolic risk. Others neonatal factors are not associated to an higher risk of EAR.

International audience; While most of the time unconsidered, child and adolescent obesity has been also associated with impaired brain health and function that can definitely affect their social interaction and integration, and then well-being and mental health. The European Childhood Obesity Group recently gathered experts in the field who discussed the main available and reliable evidence regarding the role of physical activity on brain health and cognitive functioning in children and adolescents with obesity and who propose here their main conclusions and recommendations.

No consensus currently exists on the appropriate age for the introduction of complementary feeding (CF). In this paper, a systematic review is conducted that investigates the effects of starting CF in breastfed and formula-fed infants at 4, 4–6, or 6 months of age (i) on growth at 12 months of age, (ii) on the development of overweight/obesity at 3–6 years of age, (iii) on iron status, and (iv) on the risk of developing (later in life) type 2 diabetes mellitus (DM2) and hypertension. An extensive literature search identified seven studies that evaluated the effects of the introduction of CF at the ages in question. No statistically significant differences related to the age at which CF is started were observed in breastfed or formula-fed infants in terms of the following: iron status, weight, length, and body mass index Z-scores (zBMI) at 12 months, and development of overweight/obesity at 3 years. No studies were found specifically focused on the age range for CF introduction and risk of DM2 and hypertension. Introducing CF before 6 months in healthy term-born infants living in developed countries is essentially useless, as human milk (HM) and formulas are nutritionally adequate up to 6 months of age.

Background: Health risks associated with the high consumption of sugar-sweetened beverages (SSBs) include overweight or obesity and their complications such as diabetes, as well as oral and dental decay, among others. Aim: The aim of the present statement is to inform health care professionals, parents, care-givers, teachers and school head teachers, stakeholders and governing bodies about the risks associated with drinking SSBs in infants, children and adolescents. Methods: We searched PubMed and the Cochrane databases for English language studies published from 2010 through October 1, 2018, for randomized clinical trials, meta-analyses, systematic reviews and observational studies (search terms are reported in eAppendix in the Supplement). We also manually searched the references of selected articles, reviews, meta-analyses and practice guidelines. Recommendations: Consumption of SSB by children and adolescents should be limited, and the consumption of water and other non-sweetened beverages should be promoted. Educational institutions such as nurseries, pre-schools and schools should offer unlimited access to drinking water, whereas the sale of SSBs should be banned.

Childhood Obesity : The Need to Translate Research into Daily Practice: Announcing the Annals of Nutrition and Metabolism as the Official Journal of the European Childhood Obesity Group

A case-control study was conducted to investigate the effectiveness of the Edueat® Method, through experiential workshops focused on the use of all 5 senses. In two different primary schools in the same city, questionnaires were administered in two months with a follow-up one year later. Participants: 119 children (age 8.2–9.0) chosen randomly, control group 66 (55.5%). Seven lessons of 2 h each were held in the schools by experts of the Edueat® method and seven extra lessons by the teachers. The main outcome measures were the children’s changes in their approach and attitude towards their eating habits. The answers were grouped with factor analysis and summarized through scores. Repeated-measures analysis of variance was conducted in order to identify the relationships between scores and treatment over time. At the end of treatment, the intervention group showed a significant appreciation towards healthy foods (+4.15 vs. −0.05, p = 0.02) and a greater capacity in identifying foods which are very good for the health (+15.6 vs. +14.4, p = 0.02). In conclusion, the Edueat® method was found to be particularly promising in transmitting knowledge of those foods which are healthy. Greater involvement of teachers and parents is crucial.

Adiposity rebound (AR) refers to the second rise of the body mass index (BMI) curve that usually occurs physiologically between five and seven years of age. AR timing has a great impact on patients&rsquo, health, since early adiposity rebound (EAR) is associated with the development of metabolic syndrome later in life. We aimed to investigate the prevalence of EAR in a cohort of inborn preterm infants admitted to the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Secondarily, we assessed whether some determinants such as (1) gender, (2) delivery mode, (3) birth weight and classification into small, normal, or large for gestational age, (4) type of feeding, (5) breastfeeding duration, (6) timing of introduction of solid food, (7) parental education, and (8) parental pre-pregnancy body mass index (BMI) influenced EAR in this cohort. The tertiary aim was to evaluate the prevalence of obesity or being overweight at seven years of age in children according to early versus timely AR. This is a prospective, population-based longitudinal study conducted at the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Inborn preterm infants admitted to the neonatal ward between 2009 and 2011 were eligible. Enrolled preterm infants were evaluated at birth and at 1, 3, 6, 9, 12, 15, 18, and 24 months and 3, 4, 5, 6, and 7 years of age. Weight and height data were analyzed, and BMI was calculated. AR was assessed in the growth trajectory in a body mass index (BMI) plot. Of the 250 preterm newborns included, 100 completed the seven-year follow-up and entered the final analysis, 138 were lost during the seven-year follow-up, and in 12 cases parents withdrew over the course of the study. The prevalence of EAR in our cohort of preterm newborns was 54% at seven years of age. Early adiposity rebound was associated with being large for gestational age (LGA) at birth. No other factors were associated with EAR. Early adiposity rebounders had a significantly higher BMI at seven years compared to children with timely AR (17.2 &plusmn, 2.7 vs. 15.6 &plusmn, 2.05, p = 0.021). No significant differences were found in the prevalence of obesity or being overweight at seven years of age in children with early or timely AR (29% vs. 14%, p = 0.202). Ex-preterm infants have an increased risk of EAR. Since EAR may lead to long-term detrimental health effects with the onset of various chronic diseases (e.g., obesity, metabolic syndrome, etc.), healthcare providers should be prepared to counteract its occurrence, especially in delicate sub-populations of infants.

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention. The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase. Electronic supplementary material The online version of this article (10.1186/s13052-018-0525-6) contains supplementary material, which is available to authorized users.

This study reviewed the link between social media and the growing epidemic of childhood obesity in Europe. A task force from the European Academy of Paediatrics and the European Childhood Obesity Group searched published literature and developed a consensus statement. It found that there was evidence of a strong link between obesity levels across European countries and childhood media exposure and that parents and society needed a better understanding of the influence of social media on dietary habits. Conclusion. Health policies in Europe must take account of the range of social media influences that promote the development of childhood obesity.

OBJECTIVE: To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. METHODS: A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. RESULTS: The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. CONCLUSIONS: The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.

ObjectiveTo test a surveillance system on diet and physical activity based on data gathered at well-child visits.DesignCross-sectional data collection on growth, diet, physical activity and sociodemographic variables.SettingOffices of 179 paediatricians in three Italian regions.Subjects26 898 children for a total of 32 915 well-child visits at 1, 3, 5–6, 8–9, 12, 18, 24, 36 and 60–72 months of age.ResultsThe BMI Z-score was lower than the WHO standard at 1 and 3 months but higher from 8–9 months onwards. The rates of breast-feeding at 1, 3, 5–6, 8–9 and 12 months were 88 %, 75 %, 64 %, 52 % and 32 %, respectively, with 5 % and 3 % continuing up to 24 and 36 months. Exclusive breast-feeding was 64 %, 54 % and 20 % at 1, 3 and 5–6 months, respectively; 57 % at 5 months and 85 % at 6 months were given complementary foods. Only 8 % and 10 % of children were taking five portions of fruit and vegetables daily, while 47 % and 51 % were consuming sugar-sweetened beverages at 36 and 60–72 months, respectively. At 60–72 months, less than 10 % reported at least 1 h of moderate-to-vigorous physical activity on 5–7 d/week, and 32 % watched television or played videogames for more than 2 h/d, every day. The majority of paediatricians rated the surveillance system as reliable and feasible.ConclusionsSurveillance for diet and physical activity in pre-school children, with data gathered during well-child visits, is feasible and potentially useful to plan and evaluate activities for the prevention of obesity.

Background: Interdisciplinary state-of-the-art interventions to treat obesity demand equally interdisciplinary outcome assessments. The Bariatric Evaluation Score for Children (BAREV-C) was developed to reliably and comprehensively assess the outcomes of non-surgical and surgical obesity treatment in children and adolescents. Methods: BAREV-C assesses medical, psychological, nutritional, and data of physical fitness data. The body mass index standard deviation score and waist measurement were selected to describe anthropometry. Serum triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and plasma glucose tolerance were selected as parameters of the metabolic syndrome. Relevant interdisciplinary variables were tested using the interdisciplinary Adiposity Evaluation kit, which assesses cognitive steering variables of eating and exercise behaviour as well as psychological comorbidities, exercise motivation, nutritional preferences, and quality of life associated with obesity. Physical fitness was assessed by means of the Physical fitness test battery. The values for the BAREV-C were determined in several steps and in all relevant disciplines pre and post intervention. Results: The BAREV-C facilitated the identification and quantification of significant changes of interdisciplinary variables associated with obesity for groups and individuals (tables of critical differences) as well. The degree of success or failure of an intervention can be quantified for each of the disciplines. Conclusions: The BAREV-C is the first comprehensive outcome instrument for pre-post-intervention evaluation of obese individual children as well as groups. It can be applied for intervention studies and can provide the clinician with a differentiated overview in daily practice.

The aim of the study was to examine the gross motor skill performance of overweight and non-overweight preschool children from South of Italy, and to investigate possible differences by gender.Participants were 38 boys and 42 girls (4.5 ± 0.5 yr) categorized as overweight (n = 38) and non-overweight (n = 42), according to the IOTF body mass index (BMI) cut-off points. The Test of Gross Motor Development was used to assess seven locomotor skills (run, gallop, hop, leap, horizontal jump, skip and slide) and five object-control skills (two-hand strike, stationary bounce, catch, kick and overhand throw). The raw, standard and percentile scores and the Gross Motor Development Quotient (GMDQ) were calculated for each participant. ANOVA 2 (gender) x 2 (group) was conducted on the subtest standard scores and the GMDQ.No differences in performance were found between boys and girls on the subscale standard scores and the GMDQ. Significant main effects (p0.001) were reported for group on the GMDQ, and the standard scores for locomotor and object-control skills, with overweight children reporting lower movement competence than their counterparts. Pearson's correlations revealed relationships (p0.001) between BMI and locomotor (r = -0.54) and object-control (r = 20.48) skills, and between BMI and GMDQ (r = 20.54).Findings indicate that childhood obesity might have adverse effects on gross motor development. Overweight participants showed poorer performance on locomotor and object-control tasks than their non-overweight peers. Interventions to promote physical activity in overweight children should be directed towards achieving a healthy weight and motor skill improvement.

An international consensus on the methodology of a public health surveillance system will be essential in order to have a correct understanding of the progress of the growing challenge posed by the epidemic of obesity, to make inter-country comparisons possible, and overall to evaluate the effectiveness of preventive programmes and interventions. Recently, the European Charter on Counteracting Obesity, adopted at the WHO European Ministerial Conference on Counteracting Obesity in November 2006, called as well for the development of internationally comparable core indicators for inclusion in national health surveillance systems to be used for advocacy, policy making and monitoring purposes. At present, however, there is not yet a universal agreement on the appropriate methodology to carry out an epidemiological study or surveillance system to assess the prevalence and incidence of both overweight and obesity and monitor their trends over time in children and adolescents. The current disagreement involves the diagnosis method for overweight and obesity, the reference values and cut-off points to be applied and the age of the subjects. At the moment body mass index (BMI) is the most accepted anthropometric measure to assess overweight and obesity in epidemiological studies. The new WHO child growth standards from 0 to 5 years and the International Obesity Task Force internationally based criteria for overweight and obesity among children and adolescents aged 2 to 18 years are useful tools for international comparisons.

In April 2006 the WHO released a set of growth standards for children from birth to the age of 5 y. Prior to their release, the standards were field-tested in 4 countries. The main objective was to compare children's length/height-for-age and weight-for-length/height based on the new standards with clinician assessments of the same children. The study sampled children

Adequate dietary intake of micronutrients is not necessarily achieved even in resource-rich areas of the world wherein overeating is a public health concern. In Europe, population-based data suggests substantial variability in micronutrient intake among children. Two independent surveys of micronutrient consumption among European children were evaluated. Stratified by age, the data regarding micronutrient intake were evaluated in the context of daily requirements, which are typically estimated in the absence of reliable absolute values derived from prospective studies. The proportion of children living in Europe whose intake of at least some vitamins and trace elements are at or below the estimated average requirements is substantial. The most common deficiencies across age groups included vitamin D, vitamin E, and iodine. Specific deficiencies were not uniform across countries or by age or gender. Micronutrient intake appears to be more strongly influenced by factors other than access to food. Substantial portions of European children may be at risk of reversible health risks from inadequate intake of micronutrients. Despite the growing health threat posed by excess intake of calories, adequate exposure to vitamins, trace elements, and other micronutrients may deserve attention in public health initiatives to optimize growth and development in the European pediatric population.

The construction of a school is the first pedagogical act. Its form, the relationship with nature, light, materials and colours provides important educational inputs for children. Different social, philosophical, pedagogical and architectural theories on the spaces built for and around the child have led to the construction of different kindergartens based on fantasy, over-design, sobriety, philosophical theories, and so on. Kindergartens with a surplus of architecture and furniture may reduce the child's imagination, because they are perceived as a too elaborate toy that gets boring. Furniture should provide children with metamorphic forms which adapt to their needs and preferences. The planning and design of buildings and spaces dedicated to children should consider the child at the center of the space built. The aim that architects should have in planning a kindergarten is the well being of the child, because his/her childhood will be the basis of the maturity as adult of tomorrow.

The aim of this study is to develop and test a method to perform focus groups (FGs) and to elicit the subjective views of preschool-age children on physical activity and perceived kindergarten barriers to practice it. FGs have been held in three different kindergarten classes with 49 children who were 4-5 years old. Children were asked to draw themselves in their preferred way of playing and were asked few questions about their drawings to understand their behaviours and ideas. In class A and B, 67% and 75% of the children, respectively, drew sedentary plays (table and impersonation games). Children referred that the main obstacle to perform active games outside home/kindergarten was the parents' and teachers' perceived risk that they could be hurt or catch a cold. The children would like to have more table games in the kindergarten. 81% of children in class C drew active group games. All these children were well satisfied with their kindergarten environment and did not refer to any adults' fear regarding active play. This class teacher spent a lot of time to develop children's motor abilities through active games and often used the garden to let the children to play freely. The use of drawings to understand children's habits on physical activity has turned out to be a reliable and easy tool in preschool children. The different results obtained in the two children groups show the need to change the beliefs and the behaviours of teachers and parents who seem to be non-architectural "invisible" barriers to be knocked down. This protocol has been developed by ASL Brindisi within the framework of PERISCOPE's objective to develop new methodologies.

PERISCOPE project assesses factors promoting or preventing obesity development in early age. A specifi c aim is to assess preschool children ’ s physical activity habits in three different European countries. PERISCOPE has been implemented in 1094 children attending kindergartens in Denmark, Italy and Poland. The parents ’ and children ’ s physical activity habits and attitudes assessed by a questionnaire fi lled by the parents. Overweight and obesity assessed by Cole ’ s BMI cut-off points. Statistical analysis performed by χ^2 test and the test of proportion. Denmark shows the lowest rate (14.6 %) of overweight, followed by Poland (17.1%), while Italy shows the highest (21.2 %) (p < 0.0001). The Polish families show the highest rate of walking from home to kindergarten and back, followed by the Italians and, lastly, the Danish ones (p < 0.001). Almost all the Danish and Polish children, but only the 50.1 % of the Italians play outside (p < 0.001). During the weekdays, 34.9 % of Polish children, 22.2 % of Italians and 19.8 % of the Danish play outside more than one hour a day (p < 0.0001). During the weekend, 91.1 % of Polish children, 86.7 % of Danish children, but only 54.4 % of Italians play outside more than one hour (p < 0.0001). 53.5 % of Danish children, 31.9 % of Polish children, and 18.2 % of Italian ones practice sport (p < 0.0001). Danish children are the most active, the Polish are in the middle and the Italians are the least active. The difference in infrastructures (safety of walking streets, access to playgrounds/parks, etc.) can play an important role, in addition to cultural and social family characteristics, to the development of overweight.

P>The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

Hair trace element (TE) (Cr, Mn, Fe, Zn, Cu, Br, Rb, Sr, Pb) levels from 336 healthy subjects were measured by the Proton-Induced X-ray Emission (PIXE) method. The subjects were divided in three groups: 157 full-term neonates (75 male and 82 female), 86 children (41 male and 45 female) ages 6 to 11 yr, and 93 adolescents (51 male and 42 female) 11 to 16 yr old. Cu, Zn, Cr, and Br show an increase from birth to 8 yr and then decrease. Fe, Mn, and Sr strongly decrease up to 8 yr and then remain almost stable. Sex differences are present in Fe, Zn, and Br of children and in Cu, Cr, and Br of adolescents.